Stemmer debating next step

To leave, or not to leave.That is the question local surgeon Dr. Paul Stemmer is pondering in the wake of Ridgecrest Regional Hospital’s designation as a critical-access hospital.

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By John V. Cianijciani@ridgecrestca.com

Ridgecrest Daily Independent - Ridgecrest, CA

By John V. Cianijciani@ridgecrestca.com

Posted Feb. 19, 2013 at 12:09 PM
Updated Feb 19, 2013 at 12:11 PM

By John V. Cianijciani@ridgecrestca.com

Posted Feb. 19, 2013 at 12:09 PM
Updated Feb 19, 2013 at 12:11 PM

To leave, or not to leave.

That is the question local surgeon Dr. Paul Stemmer is pondering in the wake of Ridgecrest Regional Hospital’s designation as a critical-access hospital.

Responding to rumors he is leaving the area, he said he is looking at options.

“Nothing is written in stone,” Stemmer said. “I’ve had a couple of interviews. It’s still kind of up in the air. Things at the hospital are such that it’s forcing me to look at alternatives.”

He expressed concerns about the designation.

“Number one, I’m not sure that we had to go that way in the first place,” he said. “We were told that we had to.”

Stemmer said being limited to 25 inpatients limits the number of operations that can be done.

“The way I look at it, it’s back-door health-care rationing,” he said. “The way the rules are, being a critical-access hospital gives the hospital a disincentive to take care of anything other than Medicare and Medi-Cal patients. The hospital would do less work for more money.”

He said the hospital wants all the doctors to be under its umbrella.

“Anybody who’s not is looked upon as an outsider, and that would be me,” said Stemmer. “As a way of trying to squeeze me out, they hired a third surgeon that we don’t need. People might like that because we have more options, and I agree with that. The truth is there isn’t enough work here to keep three general surgeons busy especially with the critical access, because we’re limited to 25 beds.”

He said the other two surgeons would be hospital employees.

“From that perspective, it doesn’t matter how much they work, because the hospital’s going to pay them one way or another,” he said. “My income is related in a linear fashion to how much work I do.”

Stemmer said critical-access concept is for hospitals that are believed to be truly important to a given community, but are not busy enough to stay out of the red.

“In this hospital, the number of beds occupied is 25. This hospital sometimes is below that,” he said. “A good part of the time it is at that or above it,” he said. “By going critical access, meaning we can’t have more than 25 inpatients in the hospital, means we do less work here.”

Stemmer said the hospital’s bed capacity barring legal and other limitations is approximately 80.

Page 2 of 3 - “They haven’t had the maximum of 80 patients in the hospital in a long time, but frequently I’ve had 15 to 17 patients of my own in the hospital at a time,” he said. “If we can only have 25 beds including pediatrics and obstetrics, that just can’t happen.”

He said the 25-bed limit does not count outpatients or people in the rehabilitation/transitional-care unit.

“For the outpatients, we are allowed another 10 beds for a total of 35, but 25 inpatients,” Stemmer said. “If you came in and had to be admitted, and we already had 25 patients in the hospital, you would have to be transferred.”

Asked if there any other options the hospital could have considered beside critical-access, he said he did not know the real numbers.

“When this was first presented to us, it was, ‘Oh we’re in such bad shape. If we don’t do this, we’re not going to make it,’” he said. “I don’t have the trust, confidence or faith in the administration to believe that, but I don’t have access to the numbers to know one way or another. If that’s actually true, then although it’s not a good thing, it’s better than nothing. If it’s not true, then you have to ask yourself, ‘Why did we do it in the first place?’”

Responding to hospital’s Community Update report that the increase in Medicare reimbursements would help the hospital pay the mortgage on the expansion, Stemmer said that was the rationale.

“The hospital has never actually been in the red,” he said. “Yet when go to critical access, Medicare gives you more money, especially more money for less work. In addition to Medicare and Medi-Cal, if you have insured patients in the hospital, you wind up getting less, which is where the disincentive to taking care of insured patients comes in.”

Stemmer said if the hospital were to fold, even patients on Medicare or Medi-Cal would have to be transferred.

“Hiring all these new doctors we don’t need for God knows how much money is trying to create a hospital staff that is dependent on handouts from the hospital and a hospital that’s dependent on handouts from the government,” he said.

Talking about his office schedule when he sees patients, he said it varies.

“It used to be Monday and Thursday in the office and Tuesday and Wednesday in the operating room, and Friday was sort of a malleable day,” Stemmer said. “The number of patients dried up to the point where I only needed one day a week. I frequently will open up Mondays if the patients are there. It varies according to patient load.

Page 3 of 3 - “I don’t know where all this is headed,” he said. “The biggest problem is that there is an antagonistic attitude between the hospital administration and the doctors who are not under their umbrella.”